An uncommon case of recto-vaginal fistula
Summary
Learn about a rare case of recto-vaginal fistula due to extrapulmonary tuberculosis through this on-demand teaching session. This unique case report will detail how the unusual occurrence of anorectal tuberculosis, which is usually difficult to accurately diagnose, was handled. Learn from expert medical professionals how they handled the case starting from initial symptoms such as lumbar pain, narrowed stools, to fecaloid vaginal discharge eventually leading to a favorable outcome. Join to gain invaluable insights from a rare case and how it might improve your diagnostic techniques for anorectal diseases.
Learning objectives
- Understand the presentation, diagnosis, and clinical implications of a recto-vaginal fistula caused by extrapulmonary tuberculosis, as demonstrated in the case report.
- Identify the clinical similarities between anorectal tuberculosis and other pathologies of the region that could potentially interfere with the process of diagnosis.
- Appreciate the importance of histopathological examination for the diagnosis of anorectal tuberculosis as shown in this uncommon case.
- Learn about potential conservative and surgical treatment options for recto-vaginal fistula and the associated factors impacting patient prognosis.
- Analyze and critically appraise the management taken in the case report to inform and shape future clinical decisions in similar instances.
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An uncommon case of recto-vaginal fistula due to extrapulmonary tuberculosis - Case report , Scientific coordinator: dr. Ciprian Cucoreanu¹ ² Affiliations: Author: Ioana-Daria Pavăl² 1 - Cluj County Emergency Hospital; Coauthors: Răzvan-Gabriel Pantilie², Albert Petre², Sebastian-Romeo Pintilie², 2 - ”Iuliu Hațieganu” University of Medicine and Pharmacy Cluj-Napoca. Iulia-Cezara Pop², Cezara Pop², Aniela Popescu². Introduction Case report Anorectal tuberculosis (TB) is a rare form of extrapulmonary TB, Patient S.L., female, 41 years old. that may occur alongside pulmonary TB, or independently. It is rather Medical history: pulmonary TB (X-rays, CT, histopathological examination), 2 births difficult to correctly diagnose anorectal TB due to its clinical similari- through C-section, smoking: 25 pack-years, essential hypertension. ty with other pathologies of the region. Patients relate tenesmus, ab- September 2023: • lumbar pain and loss of apetite; normal discharge, suppurations, adenopathies, but the most common • narrow stools — 3-4 months with rare bloodspots; sign is anal fistula. To assess the positive diagnosis, it is mandatory to • sudden fecaloid vaginal discharge. perform a histopathological examination of the excised fistula, howev- Conservative treatment: temporary lateral baguette sigmoidostomy in the left iliac fossa er the pathognomonic caseation is inconstantly present. (LIF). Recto-vaginal (RV) fistulas are a pathological epithelialized tunnel May 2024: MRI examination - scar tissue in the lower rectum, stenosis, no visible fistu- through the RV septum, that affect the patient’s quality of life and lead lous tracts (fig.1, fig.2, fig.3). to several life-threatening complications. Most common causes in- Diagnosis: RV fistula complicated with a complete lower rectal stenosis, anorectal TB clude: iatrogenical, diverticular disease, inflammatory bowel diseases. (caseous nodule in the RV septum). June 2024: ultralow anterior resection of the rectum, with a mechanical T-T colo- Discussions & Conclusions anal anastomosis: Even though it is a rather unique case of anorectal TB, the patient’s • exploration of the region, an attempt to mechanically dilate the stenosis; • median abdominal laparotomy; evolution was favorable, being discharged with present bowel move- • dissection of the mesorectum and the sigmoid mesocolon (Ligasure) - to isolate the ment, a clean surgical wound and a remaining baguette colostomy in superior rectum; the LIF. The surgical solution involved an ultralow rectal resection • transection of the superior rectum from the stenosis area; with colo-anal anastomosis, keeping a protective stoma in place, with • mechanical T-T colo-anal anastomosis with a circular 28mm Covidien; a very good outcome at 5 weeks postoperatively. Due to the lack of • drainage. similar documented cases in the literature, we consider it important to present this case. Fig.2 Fig.1 References: Fig.3